the Transition Services Program Application

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Polk Transition Services
The Mission of Polk County Public Schools is to ensure rigorous, relevant learning experiences that result
in high achievement for our students. Polk Transition Services vision is to provide a continuous process
that begins by the time a student turns 14, or is in the eighth grade whichever comes first and continues
until the student graduates from high school or for special diploma students until the school year they
turn 22 years of age. Transition planning focuses on the plan and dreams that a student has for the
future and provides the services and supports that the student needs to make a successful move into
adult life.
PROGRAM FOCUS
The program focus has 5 major points: Student Focused, Family Involvement, Student Development,
Program Structures, and Interagency Collaboration. Polk Transition Services will focus on Postsecondary
Education, Parental Support, and Transition Skills. We have transition programs at several of our high
schools, area colleges and universities, with several business partnerships throughout Polk County.
These programs provide an opportunity for students 18 – 22 years of age to work toward their desired
postsecondary goals. We address the students wherever their current needs are to transition into
adulthood through continued education, work experience, and leisure activities. Polk County Transition
Program has developed and modeled its program using the Kohler Taxonomy for Transition
Programming:
STUDENT FOCUSED PLANNING
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IEP Development
Student Participation
Planning Strategies
FAMILY INVOLVEMENT
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Family Training
Family Involvement
Family Empowerment
STUDENT DEVELOPMENT
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Life skills Instruction
Employment Skills Instruction
Career and Vocational Curricula
Structured Work Experience
Assessment
Support Services
PROGRAM STRUCTURES
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Program Philosophy
Program Evaluation
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Polk Transition Services
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Human Resource Development
INTERAGENCY COLLABORATION
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Collaborative Framework
Collaborative Service Delivery
THE APPLICATION PROCESS:
The School District of Polk County, Department of Exceptional Student Education (ESE), and Transition
Services Program provide an opportunity for 18 – 22 year old students who have graduated with a
special diploma and who desire to attend school for postsecondary training. Opportunities are on High
School Settings and Non Traditional Settings. The District Office will make the site selection best suited
for your student, the program will offer:
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Career Experience
Meaningful Peer and Adult Interactions
Family interaction for academic and work experience
The application process for Polk County School based students: complete the application with your
parent and return to the LEA at your assigned high school. A brief interview process will be conducted
with the LEA and District Office Personnel. Assignment will be given during that academic school year.
For students who have graduated and wish to return complete the application with your parent and
return to any high school or the District Office: The District Office will contact you for an interview for
admission.
Polk County School Board
Attn: Transition Office
P.O. BOX 391
Bartow, Fl 33831
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Polk Transition Services
CRITERIA FOR ACCEPTANCE INTO POLK TRANSITON SERVICES
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The student must be between the ages of 18 and 22 years
The student must have graduated with a special diploma
The student must actively be working toward the goal of becoming an independent member of
society
The student must have a good work ethic
The student will adhere to the code of conduct
The student must be able to function with minimal supervision and support
The student must demonstrate appropriate behaviors in community settings
The student must be willing to attend campus required activities
Students may have the opportunity to sit in a post secondary class or program as seats are
available as a non graded observer
Students will be transported by Polk County School Board bus, parent’s, or public transportation
Parental involvement is REQUIRED ( support student’s independence and paid employment,
attend meetings, sign and return paperwork, overall support)
Student must have a letter of recommendation from a teacher, facilitator, or building
administrator
Student must be willing to participate in career experiences on or off campus for approximately
10 hours per week.
Acceptance will be determined by the school and district personnel upon review of the application,
review of the IEP, attendance and discipline records, and appropriateness of placement for the student
(Least restrictive environment).
If a slot is offered and refused student will be referred back to last school of assignment
I have read and agree to the above criteria. Failure to maintain the criteria may result in being referred
back to the last school of assignment.
Permission to Photograph
On occasion, students will be photographed; videotaped, filmed, and/or interviewed for newspaper
articles, brochures, television, and public information presentations.
I hereby grant permission to be photographed and/or interviewed.
Student Signature
Parent Signature
Date
Date
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Polk Transition Services
Polk Transition Service Student Application
Contact Information
Name
Street Address
City ST ZIP Code
Student Id#
D.O.B.
Phone
Referring Teacher
School Information
Current/ Previous High School: _________________________________________________
___ # days absent
______ year graduated
___ # discipline ref.
___ anticipated graduation
Interests
Tell us in which areas you are interested/ likes and dislikes
___ Office Work
___ Outdoor Work
___ working with people
___ working alone
___ cafeteria
___ detail work
___ working with pets
___ other
______________________________________________________________________________
Special Skills or Qualifications / Teacher/ Parent input /Comments
Summarize special skills and qualifications and important information about your students ability to
work with others and work independently
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Polk Transition Services
Health Concerns/Medications
Please be very detailed.
Person to Notify in Case of Emergency
Name
Street Address
City ST ZIP Code
Home Phone
Work Phone
E-Mail Address
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand
that if I am accepted as a student with Polk Transition Service, that I must follow the Code of Conduct
and criteria as written, if not I will be referred back to my last high school of record.
Name (printed)
Signature
Date
The Vision
Polk Transition Services, vision is to provide a continuous process that begins by the time a student
turns 14 and continues until the student graduates from high school. Transition planning focuses on
the plans and dreams that a student has for the future and provides the services and supports that the
student needs to make a successful move into adult life.
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Polk Transition Services
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